Occupational Therapists (OTs) offer an amazing service to families.
They can help with so many different challenges that children face, everything from sensory aversions to an inability to focus to toileting issues.
If you haven’t heard about OTs before or don’t know much about them, check out this short Q & A I put together after talking to an amazing OT in Toronto, Meghan.
She shares a lot of great info about when OTs can help, what they do, and how to access their services.
She also answers a couple great questions at the bottom about why movement, risky play, and gross motor development is essential for children.
What do you do? How do you help children and their families?
Occupational therapists help support participation in daily living activities. We can help with so many different tasks when you’re talking about children, including self-care skills (eating, toileting, washing), productivity (school tasks, like writing and other fine motor skills), or leisure and play activities (participating in activities within the community).
What’s special about our role is that we look at the whole child, the person, and their environments. We want to consider all factors that would contribute to any challenges they’re having.
We look at a child’s overall development, their ability to regulate their emotions and responses in specific situations, physical challenges, motor skills, sensory preferences/dislikes, and independence skills. In particular we’re considering a child’s participation within the home and school environments. We then offer a tailored treatment plan based on these considerations.
We also consider other impacting factors for how a child may be presenting, this could include how much sleep they’re getting, what their nutrition is like, if they have a relevant medical history, what family or school stresses they have, etc. We look at more than just what’s happening with their body and take a holistic approach.
What's the difference between Occupational Therapy (OT) and Physical Therapy (PT)?
We tend to work very closely with physiotherapists and often rely on their physical assessments for our treatment plans. These assessments can give us a lot of information about a child’s movement patterns, muscle strength, and endurance. Where a physiotherapist focuses in detail on an individual’s physical functioning, an OT focuses more on the activities/daily living skills that are impacted.
We often combine info about an individual’s physical limitations/differences with how their physical limitations may be affecting their engagement in meaningful tasks right now, and look at it in combination with other factors such as cognition, learning, sensory processing, fine motor, or gross motor challenges.
Our treatment plans then focus on not only skill development, but also on creating environments that allow the child to participate as fully as possible.
For instance, if a child was struggling with handwriting, we’d look at their ability to hold the pencil, general motor skills, hand eye coordination, their pincer grasp, literacy, focus, attention, posture and desk set-up, motivation and interest in the activity, where handwriting physically occurs, pre-printing skills… the list goes on.
From this evaluation, we’d create a plan to address the child’s specific needs, as well as a plan to educate and collaborate with the adults in their life that will help them.
What specific challenges do you help children with? When should parents consider having their child evaluated for help from an OT?
Anytime a child is struggling to participate in daily living activities, then you can contact an OT for an evaluation.
I tell people to consider how disruptive a particular challenge or issue really is to the child’s life right now and how it could affect the child long-term. Everyone is different and has their strengths/challenges, not every difference requires intervention and what really matters is how impacted daily life and activities are.
For example, if a child is struggling to hold a crayon or other writing utensil in school then early intervention is a great way to keep them on track with the rest of their class to they can partake in written tasks for learning.
However, if a child has some minor sensory aversions, like they just don’t like getting their hands dirty or muddy, but it’s not really getting in the way of everyday life, then they might not need intervention. It could be something they outgrow, but even if they don’t, it’s likely not a big deal. They can still be a fully functional member of society and just prefer not to get their hands muddy.
Here’s some examples of what OTs help with:
Handwriting and other fine motor skills
Self-care - teeth brushing, hair washing, dressing, etc.
Body awareness and gross motor movement
Sensory issues - looking at overall Sensory profile - what is calming and organizing
Upregulation - high energy, inability to regulate their body, inability to sit and focus
It’s important to keep in mind that we’re not always correcting or completely changing a behaviour. Oftentimes we’re finding accommodations, changing the environment and teaching self-advocacy.
How do families access OT?
If you live in Ontario, you can usually request an evaluation through your school. If your child is not in school yet or it’s not something offered in your school system, you can likely reach out to your family doctor or childcare provider for a referral.
When it comes to children who frequently mouth things after infancy, i.e. chewing/sucking on things, what's normal and when should parents be concerned?
Oral stimulation is so common in children and often not something you need to worry about long-term.
There’s so many touch receptors in the mouth, so it’s a great way to learn about things. Children are sensorial learners so it makes sense that they want to use such a sensory rich part of the body to learn.
If your child is doing this beyond infancy and they’re otherwise developing normally, you can start by offering a piece of chewelry (chewable jewelry) and see if that helps. The biggest concern is ensuring that what they’re chewing on is safe and chewelry provides that.
Like any other issue you’re concerned about, consider how it’s affecting your child’s life. If it begins to impact their life in a meaningful way, whether that be their eating habits, dental hygiene, social skills, etc, then consider getting an OT evaluation.
How can an OT help children with upregulation or those that struggle to regulate their bodies and emotions?
When we do an evaluation for a child with self-reg issues, we look at things like body awareness, gross motor skills, if they’re meeting their milestones, how much they rely on their vision to complete movements, are they leaning on things a lot or pushing other children (indicative that they’re looking for lots feedback on where their body is), if they bang into things a lot, etc.
We also look at what sorts of activities are calming to the child. We consider all of the senses and how they may be impacting, e.g. sensitivity to sound can cause some children to appear active and have difficulties settling their bodies. It's important to create an overall sensory profile that we can use to create a custom treatment plan.
Children with sensory-regulation issues usually benefit from heavy muscle activities, work where we put resistance on the muscles and joints. These help organize the body and mind, allowing them to focus better.
If you notice that your child is overly stressed, anxious, or emotional, and/or avoids socializing, it’s a good idea to get an evaluation.
What are your thoughts on providing lots of opportunity for movement in young children, specifically those under 6? How important is it? Are there any guidelines parents should be following?
It’s so important for young children to move. It’s essential. I think this chart really illustrates that:
You can see that the foundation for all higher learning (cognition and intellect) is based on a foundation of learning to understand and coordinate the sensory systems (tactile, vestibular, proprioception, visual, etc).
The development of these sensory systems in young children happens with movement and exposure to different sensory inputs.
Children need to move around - jump, swing, run, roll, etc. They need to develop awareness of their muscles and joints, how their body moves, and how they can control it.
The vestibular (movement and balance) system is located in the inner ear, and it needs to be moved and developed in childhood. If not developed, it can result in instability, sensitivity to movement, difficulty balancing and a dislike of being off-balance.
The best type of learning for a child under 6 is play through movement.
What are your thoughts on risky play (i.e. the importance, what to consider, etc)?
Risky play is essential for children for a number of reasons.
First, it’s a good way to learn. When they climb a chair and fall off, their brain problem solves how to do it correctly next time.
Lots of movement and different types of movement is also essential for motor coordination - climbing, rolling, jumping, etc. This is what develops the vestibular sense, the base of the Pyramid of Learning (in the image above).
Risky play also helps to develop empathy. When you hurt yourself, you realize you can get hurt and it teaches the growth mindset - when I practice something I get better at it.
Lastly, children also feel a sense of achievement when they master a new ability. Giving them the time and space to do this will help their confidence.
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